A research review of the key information, such as causes, microbiome involvement, bone marrow transplant success and natural compounds you should consider if diagnosed with Multiple myeloma, MGUS or smouldering myeloma.
i) What is Multiple Myeloma?
Multiple Myeloma, Plasma Cell Myeloma or simply Myeloma. accounts for just 1% of all cancer. It is a rare blood cancer that forms in the bone marrow from B-cells, with a mean age at diagnosis of 69 years. Men develop more than women.
MM is characterised by the presence of abnormal immune system plasma cells, with potential for uncontrolled growth inside the bone marrow, and promoting osteoclast development causing destructive bone lesions (79% of patients). This is why Myeloma is also sometimes called Bone cancer. The excess of abnormal plasma cells can also cause acute kidney injury (19% of patients), anaemia (73% patients), and hypercalcemia. On diagnosis 28% of patients are stage 1 and their median 5 year survival is 82%.
Despite new treatment options and bone marrow transplants which have greatly increased survival times, the disease remains ‘officially’ incurable. The B-cell origin gives it many similarities to B-cell lymphoma.
There are two 'early' stages:
Smouldering Myeloma is an early sign of MM, with precancerous plasma cells. It is asymptomatic. It is usually detected through blood tests where results show specific plasma antibody proteins, or from already having abnormal cells in the bone marrow..
Monoclonal gammopathy of undetermined significance (MGUS) - the title says it all. Monoclonal proteins (M protein) appear in the bloodstream. Gammopathy is the production of immunoglobulins to the abnormal proteins. This non-cancerous condition may evolve into Myeloma, or it may not. Hence undetermined significance. And there are less abnormal plasma cells in the bone marrow than with smouldering MM.
In summary, myeloma is a disease of the plasma cells, which are B-lymphocytes, made in the bone marrow. You have two types of B lymphocytes,
Plasma cells make proteins to fend off infection. Abnormal protein from damaged plasma cells is commonly called M protein. M protein (myeloma protein) shows up in your blood if you have abnormal plasma cells. There are a number of names for M protein - "monoclonal " proteins, monoclonal immunoglobulin, M spike, or paraprotein. Oncologists will usually talk about your Paraprotein level.
The question we will look into first is ‘why do the healthy plasma cells become abnormal?’, then secondly, ’are there natural ways of reversing them or dealing with the situation?’
One of the biggest issues is that there is only a limited amount of research on Myeloma and nothing like the volume of research, for example, on the other B-cell cancer, lymphoma.
ii) There are two parts to the immune system
I should explain this. You are born with an Innate Immune System. This is primitive and contains T-lymphocytes that attack any bad guy entering the body.
If they lose the fight, dendritic cells come along, pick up a piece of the bad guy and hand it on a plate to the B-lymphocytes. They react specifically to it and create proteins called antibodies, which are like jigsaw pieces and fit the attacker (be it a pathogen, a virus or a toxin) exactly and neutralise it. This is the Adaptive Immune System in action - built in response to infection throughout your life. In particular, it is built in response to the volume and diversity of your gut microbiome, every minute of the day. Damage your microbiome (drugs, antibiotics, poor diet, too much sugar, food poisoning, stress, smoking, binge drinking and more) and you will damage your adaptive immune system.
T-cells or T-lymphocytes are made in the bone marrow from stem cells and mature in the thymus. There are a number of different types. They tend to operate within cells and protect us from infection.
B cells or B-lymphocytes are also made in the bone marrow from stem cells. They operate outside cells. B-lymphocytes also secrete cytokines, which are chemical messages that can't enter the cells but can direct hormones and other factors to launch an immune attack.
T- and B-lymphocytes are termed white, or immune, blood cells. The bone marrow is part of the lymphatic system, which also includes the lymph nodes (or lymph glands), spleen and thymus.
When people have chemotherapy, their white immune cells take a big hit, exposing the patient to infection because white cells protect you from infection. This is why you are given antivirals and antibiotics. They don't always work and patients still get infections!! We have natural compounds that do work.
iii) Myeloma causes
Older people develop more, males develop more, and it is more common in developed countries.
Myeloma may run in families. 24 alleles (gene variations built over time) have been identified in MM patients (1).
Other factors that increase the risk of lymphoma include -
a) Environmental toxins e.g. Agent Orange, glyphosate, benzene, diesel fumes, persistent organic pollutants, DDT, Lindame, Dichlorophenoxyacetic acid, malathion and more. I've helped farmers with MGUS (they are 0.4% of the population but account for 8% of MGUS), aero-industry professionals, firemen and oil platform workers; and the US has a Veterans study looking at war time exposure to chemicals. A number of toxins that cause leukaemia and lymphoma are also believed to increase Myeloma risk (the lowered volume of the disease results in less research.
See - Cancer in the workplace
See - Pesticides and cancer
b) Toxins you ingest such as drinking water contamination, super processed foods, aspartame, and certain drugs (Insulin, Prednisone, Erythromycin, Phenytoin and some gout medications such as colchicine) have been shown to increase risk.
c) Toxins you receive from infections
* EBV is a member of the human herpesvirus family (Herpes 1, 8 - cold sores - and HPV are others). Where young people are infected, they are often asymptomatic. EBV has been linked to Myeloma (2).
The virus is a potent lymphotropic agent capable of transforming B-cells in vitro into a state of continuous proliferation called ‘immortalisation’. EBV is also known to be linked to B-cell lymphoma.
* Helicobacter pylori, Researchers at Inserm, Nantes, France have been studying whether infections can contribute to the onset of Myeloma via the myeloma protein - they found a link between hepatitis C, cytomegalovirus, and HIV. Helicobacter pylori is also linked to B-cell lymphoma and seems linked to MGUS and Myeloma.
* HIV infection and the resulting immunodeficiency are linked to higher rates of lymphoma, leukaemia, MGUS and Myeloma and plasmacytosis. Studies have shown a 4.5 fold increased risk of MM (17). In people with MM and HIV there is a significantly higher level of ExtraMedullary Disease (in soft tissues such as liver, kidneys, lymph nodes, breast and pleura) rather than confinement to the bones.
d) Other factors
* Cholesterol and Myeloma - a study which reviewed lipid levels and myeloma risk, came to a surprising conclusion: It showed that patients with lower lipid levels and high (good) HDL-C are at increased risk of developing MM (3). This is possibly a poor conclusion. For example, we know that cholesterol levels are lower in MM patients because of high use of cholesterol by MM cells (18). And we know that the use of a lipophilic statin to reduce cholesterol levels, increases survival in MM (19).
* Diabetes - people with diabetes have lower survival rates - Diabetes and poor sugar control seem to speed the progression of the disease (4).
* Sugar - But it seems likely that it is not just sugar that stimulates myeloma aggression but the fact that intake of sugar promotes insulin levels, and this also has an effect. In 2009, advocacy by the International Myeloma Foundation (IMF) led to PET scans being adopted as an important part of myeloma treatment - they were recommended by the IMF because ‘Myeloma cells love to eat sugar’.
Because Dexamethasone usage is known to increase blood sugar which causes an increase in insulin, the IMF suggested patients tracked their blood sugar levels and considered the use of Metformin (we prefer Berberine) if they were taking Dexamethasone.
White cells are obviously an important part of the immune system. We have an article '20 links between sugar and cancer'. There is an opening section on the damage sugar consumption can cause to the immune system, so much so that Scientific American in its review talked of sugar consumption causing 'a temporary coma' in the immune system! Sugar consumption would be expected to have an influence on MM.
* Obesity - Bone Marrow fat expands during aging and in obesity. Researchers have shown that obesity is linked to increased Myeloma risk.
iv) The Bone Marrow Microenvironment and Myeloma
First you need to know that there is a microenvironment in the bone marrow; it has its own microbiome. And, as we will see, the health of your gut microbiome helps determine the quality of the bone marrow microbiome. It is fatty, but the exact makeup of fat is found nowhere else in the body.
Next, you need to know that Stem Cells were the blob of cells that first grew rapidly when you were an embryo. From your stem cells all body cells 'differentiated' to form your liver, kidneys, eyes, brain etc.. Throughout your life, stem cells are the repair cells for your whole body and can convert at any age into other cells - liver, stomach lining or lung cells etc.. Whatever you need.
Stem cells in the bone marrow give rise to your immune T-cells, B-Cells and osteoclasts and osteoblasts (your bone cells) and malignant myeloma cells are heavily dependent upon the altered bone marrow microenvironment for their existence and survival.
* One component, B-Cell Activating Factor (BAFF), plays a part in normal B-cell (lymphocyte) development, but has also been implicated as a key player in tumour development. BAFF is present in the blood in much higher levels than normal, in MM patients and seems to play an important role in pathogenesis of MM and is at its highest levels in aggressive cases.
* B-lymphocytes, or B-cells' normal role is producing immunoglobulins and antibodies within the adaptive immune system.
* High BAFF is also found in people with Rheumatoid Arthritis, an illness now known to be linked to an unhealthy microbiome.
* BAFF is also increased in people with gum problems and seems linked to macrophages - blocking BAFF, reduces inflammation.
It may be worth having a Dental Check up.
Some stem cells get 'stuck' in their rapidly dividing form, usually under the influence of oestrogen - however, research suggests it is possible that, for example, EBV can do this too. These can become Cancer Stem Cells at the heart of a cancer. No conventional drug kills them and they generate rapidly dividing irregular B-lymphocytes. They are therefore cells that can lead to recurrence.
Bone Marrow Microenvironment - The understanding of this is in its infancy. Much of the research on PubMed is in the past 2 years! New research talks often about the formation of micro-RNA and how damaged micro-RNA in the bone marrow may be behind damage to B-cells. Natural compounds such as Turmeric, Resveratrol and Genistein have research on how they correct these micro-RNAs. They are also compounds which have an effect on stem cells, and stem cells generate the B-cells.
The bone marrow has its own microbiome. Bone marrow health, bone marrow fat and stem cells, which are formed in the marrow, and go onto make osteoclasts, osteoblasts, T-cells, B-cells and others, are all intertwined.
Stem cells and B-cell progenitors are crucial to your health. They both exist in the bone marrow and ensure new healthy white cells are made. When B-cell myeloma occurs, it seems that the stem cells are less likely to make fully formed or mature B-cells (5). In both myeloma and lymphoma, the current theory is that in acting against pathogens, a B-cell turns rogue and then starts copying in the bone marrow. In one study, the health of the bone marrow was linked to the health of lymphocytes and vice versa (6). This review contains a list of research papers on the subject.
Marrow lipids (fats) are essential to the health of your bone marrow and there is a high turnover of fats in the bone marrow (7).
In another study, 'powering up' the adipocytes powered up the bone marrow lipid content and generated healthier blood cells (8). How did the researchers power up the Bone Marrow? They gave patients Metformin - ordinarily this diabetes drug is used to cut blood sugar. It control sugar by affecting the liver. In this research it unexpectedly changed the bone marrow lipid profile for the better and pushed out abnormal B-cells.
v) The Role of the Gut microbiome
Not surprisingly, there are several research studies showing that your gut microbiome can affect your bone marrow microenvironment (9), Be clear; not just the pathogens (parasites, bacteria, viruses) but the commensal (good) bacteria in the gut microbiome too.
Other studies, (for example, 6) show that damage to the gut microbiome by drugs and antibiotics (and food poisoning etc) can CAUSE blood and lymph cancers (obviously by affecting the bone marrow microenvironment).
In 2015 there was a review by UCLA experts on how pathogens in the microbiome of the gut could cause B-cell lymphomagenesis (10). The bottom line from these researchers was that pathogens can directly interact with immune cells causing oxidative stress, and with epithelial cells causing increased Reactive Oxygen Species (bad) and inhibition of NF-κB. Oxidative stress (also bad) is well understood to cause message damage from your DNA and lead to carcinogenesis. For information, Melatonin and Glutathione (the two biggest antioxidants you make yourself) neutralise ROS and Free Radicals in the cellular microenvironment. CoQ10 and ‘total’ Vitamin E can help.
Gut bacteria alone can cause an immune response to a pathogen and change the lymphocytes. The researchers made the point that the family Lactobacillus (250 family members or strains) seems to be significantly protective in this change.
In Myeloma much the same has been found. A healthy gut microbiome contributes to a healthy immune system. However disruptive changes to the microbiome can cause progression in Myeloma (11). The researchers also noted that problems in the gut microbiome caused problems with stem cell transplant success.
Loss of good bacteria, gain of 'bad', is a driving force in all cancer.
Nitrogen production - One study showed that nitrogen-recycling bacteria such as Klebsiella and Streptococcus were significantly enriched in MM and MM-enriched bacteria likely result from the regulation of urea nitrogen accumulated during MM progression.It could well be a downward spiral in favour of the cancer. The interaction between MM-enriched bacteria and MM progression seems to recycle urea nitrogen. Klebsiella pneumoniae was shown to promote MM progression via the production of glutamine (normally an amino acid high in meat). Mice fed with glutamine-deficient diet exhibited slower MM progression (12). In the Keto Diet only 8% of calories may come from protein - this is to limit glutamine.
To rebuild your gut you can follow the reference at the bottom of the page, to Chris Woollams HealthWatch
Stress - The IMF points out that stress severely constrains the immune system, and Myeloma is a cancer of the immune system.
Stress can also increase your blood sugar levels, cause the production of Cortisol and Adrenaline which greatly increase inflammation throughout the body; and thirdly stress causes a significant decrease in commensal (good) bacterial levels in the gut and this affects cancer in cells throughout the body.
vi) Conventional Multiple Myeloma Treatment
Among all patients with multiple myeloma, standard first-line therapy consists of a combination of an injectable proteasome inhibitor (Bortezomib, or Velcade), an oral immunomodulatory agent (Lenalidomide), and Dexamethasone, a steroid. This combination alone is associated with median progression-free survival of 41 months, compared with historical reports of just 8.5 months without any therapy. When this therapy is combined with an autologous stem cell transplantation life expectancy can increase beyond ten years.
Remission using the first line drugs can last from months to up to 6 years and possibly more. If remission ends, some Hospitals use a Stem Cell Transplant (also called a Bone Marrow Transplant) (13).
This can be autologous (your own) - there is no doubt that survival times and rates are improving, although this depends on factors such as age and risk level (14).
Or allogeneic (from a donor), where 5 year survival is 22%. 12 out of 85 patients survived more than 10 years (15).
A dendritic cell vaccine for MM has been shown to increase survival further (16).
The SCT procedure is typically - first kill off all white B-cells with high dose drugs (usually 2 drugs and 4 rounds), and then give you a stem cell transplant (either from your own pre-collected bone marrow cells or from a matching donor. We have seen a stem cell transplant provide 10 years of relief; repeated and provide another 6 years
Importantly, we know that the stronger your microbiome, the more successful the SCT.
A maintenance dose of Lenalidomide may also be used.
Monoclonal antibodies and immunomodulatory drugs are being added to the treatment repertoire and CAR-T cell therapy is increasingly used after relapse. Chimeric antigen receptor T-cell therapy (CAR T-cell therapy) gets immune T- lymphocytes to fight cancer by upgrading them in the laboratory so they can better seek and destroy cancer cell, even in myeloma patients who have previously been treated with many drugs.
vii) Multiple Myeloma info:
* See The CANCERactive Overview on Multiple Myeloma
* See The CANCERactive Latest News and research on lymphoma - so when anything new comes up that you could use, we add it.
viii) Can Natural Compounds help treat Multiple Myeloma? A review.
a) There is great interest in Natural Compounds, because the drugs can be so harsh.
b) Moreover, I am really interested by the fact that this cancer may well be caused by microbiome problems and particularly infections. And, of course, the harsh drug treatments make the microbiome even worse.
c) We know some natural compounds have been shown in research to help fight Multiple Myeloma. Here, I have tried to find out what actual research exists and how good it is - I have not included general research or reviews. I have also put all references against the compound for ease of reading.
i) Fucoidan -
Fucoidan inhibits angiogenesis induced by multiple myeloma cells - 2016 - https://pubmed.ncbi.nlm.nih.gov/27498597/
Overall - https://cancerci.biomedcentral.com/articles/10.1186/s12935-020-01233-8
ii) Berberine
Identification of berberine as a novel drug for the treatment of multiple myeloma - BMC Biol. 2020 Mar 25;18(1):33 - https://pubmed.ncbi.nlm.nih.gov/32213189/
Discovery of the oncogenic MDM2, a direct binding target of berberine and a potential therapeutic, in multiple myeloma - Functional Genomics and Integrative Genomics, July 2022, https://link.springer.com/article/10.1007/s10142-022-00880-6
pages1031–1041 - https://link.springer.com/article/10.1007/s10142-022-00880-
iii) Honokiol
Honokiol overcomes conventional drug resistance in human multiple myeloma - Blood. 2005 Sep 1; 106(5): 1794–1800 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895215/
Honokiol is a FOXM1 antagonist - Cell Death & Disease volume 9, Article number: 84 (2018) - https://www.nature.com/articles/s41419-017-0156-7
Honokiol also has strong properties against angiogenesis like the drugs Lenalidomide and Bevacizumab -
https://biosignaling.biomedcentral.com/articles/10.1186/s12964-022-00838-y
iv) Feverfew (parthenolide)
Parthenolide-induced apoptosis in multiple myeloma cells - Apoptosis, 2006 Dec;11(12):2225-35 - https://pubmed.ncbi.nlm.nih.gov/17051330/
Inhibitory effects of parthenolide on the activity of NF-κB in multiple myeloma - J Huazhong Univ Sci Technolog Med Sci, 2015 Jun;35(3):343-349 - .https://pubmed.ncbi.nlm.nih.gov/26072071/
v) Vitamin D
Deficiency in MM patients, Pre-clinical research indicates that low vitamin D may be meaningfully involved in the development and progression of MM; review - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047650/
Significant increase in vitamin D reduces Peripheral Neuropathy in Myeloma patients - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9879810/
vi) Turmeric -
Anti-Cancer Activity of Curcumin on Multiple Myeloma - 2022 Review: multiple effects - https://pubmed.ncbi.nlm.nih.gov/32951583/
2022 Clinical Trial: Curcumin as adjuvant therapy to improve remission in myeloma patients: 8 gm used alongside melphalan and prednisone - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9301229/
vii) Resveratrol -
Resveratrol inhibits myeloma cell growth, promotes bone health - https://pubmed.ncbi.nlm.nih.gov/16267019/
Resveratrol as a novel agent for treatment of multiple myeloma - https://pubmed.ncbi.nlm.nih.gov/17049120/
NB. There is a lot of research on the effects of Resveratrol with Cancer Stem Cells.
viii) Genistein -
Genistein inhibits the proliferation of human multiple myeloma cells - https://pubmed.ncbi.nlm.nih.gov/26718793/
Genistein inhibited proliferation and induced apoptosis in MM cells - https://www.tandfonline.com/doi/abs/10.3109/10428194.2011.598251
Genistein down-regulates the constitutive activation of nuclear factor-κB in human multiple myeloma cells - https://onlinelibrary.wiley.com/doi/abs/10.1002/ptr.2715
ix) Quercetin -
Quercetin suppresses the proliferation of multiple myeloma cells - 2014 - https://pubmed.ncbi.nlm.nih.gov/24397597/
Quercetin inhibits the proliferation of multiple myeloma cells - 2021 - https://pubmed.ncbi.nlm.nih.gov/34558606/
Quercetin Displays Anti-Myeloma Activity and Synergistic Effect with Dexamethasone in vivo - 2015 - https://ashpublications.org/blood/article/126/23/5339/134279/Quercetin-Displays-Anti-Myeloma-Activity-and
x) Melatonin -
Blood and lymph cancers, chemotherapy aid - https://www.eurekalert.org/news-releases/844487
xi) Thiamine -
Thiamine deficiency in Stem Cell Transplant patients - https://www.sciencedirect.com/science/article/abs/pii/S2152265014001621
xii) Aspirin -
Aspirin use increases survival in MM - 2022 - https://pubmed.ncbi.nlm.nih.gov/34862208/
xiii) Selenium and lymphoma.
Selenium reduces mixtures of Environmental toxins harmful to health - https://www.sciencedaily.com/releases/2023/10/231030110712.htm
xiv) Cannabis and lymphoma
Cannabis appears to help standards treatments work against MM - https://www.mdpi.com/2673-9879/2/3/24
xv) Habb-e-Asgandh (homeopathy)
Habb-e-Asgandh suppresses Cell Proliferation and Induces Apoptosis through Mitochondria Dysfunction in Multiple Myeloma Cells - 2022 - https://pubmed.ncbi.nlm.nih.gov/36444574/
xx) Gambogenic acid (Garcinia hanburyi) and myeloma
Gambogic acid inhibits multiple myeloma mediated osteoclastogenesis - https://pubmed.ncbi.nlm.nih.gov/25034231/
Gambogenic acid synergistically potentiates bortezomib-induced apoptosis in multiple myeloma - https://pubmed.ncbi.nlm.nih.gov/28382147/
xxi) Withanolide and myeloma
Withanolide is a group of compounds found in the Nightshade family - for example in Ashwagandha. They appear to target chemo resistance in myeloma - https://pdfs.semanticscholar.org/26d7/b28ac5f8c7d0a2f261e80a496641f0cb65a7.pdf
Structure-Activity Relationships of Withanolides as Antiproliferative Agents for Multiple Myeloma - 2021 - https://pubmed.ncbi.nlm.nih.gov/34445874/
xxii) Celastrol (Thunder God Vine root) and Myeloma
Celastrol Attenuates the Invasion and Migration and Augments the Anticancer Effects of Bortezomib (Velcade) - https://pdfs.semanticscholar.org/26d7/b28ac5f8c7d0a2f261e80a496641f0cb65a7.pdf
Celastrol induce apoptosis of human multiple myeloma cells - https://pubmed.ncbi.nlm.nih.gov/30928629/
xxiii) Modified Citrus Pectin (MCP)
There is a lot of research on the role of Galectin-3 in myeloma. MM cells express Gal-3. It is known to drive factors such as angiogenesis, metastases and chemoresistance in Myeloma. While there is no specific research with Myeloma, Modified Citrus Pectin is known to bind to and block Galectin-3.
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Natural compounds and lymphoma - The bottom line
There is an overall review on plant natural compounds with MM - not wonderfully helpful - https://pubmed.ncbi.nlm.nih.gov/34072312/
Personally, I'd really be looking at Vitamin D, Turmeric, Resveratrol, Quercetin, Genistein, Honokiol, Berberine, and Aspirin. I might add Feverfew and Fucoidan and MCP, the latter definitely while on chemo drugs..
If on drugs, I’d be looking to add Ashwagandha, Celastrol and Cannabis.
If you’re about to have a stem cell transplant I would take Thiamine and as soon as possible after I’d do a complete gut rebuild.
Go to: How to Heal Your Gut
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References
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Genetic predisposition for multiple myeloma; Maroulio Pertesi et al; Leukemia volume 34, pages 697–708 (2020)
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The association of EBV infection with Myeloma; Mohammad Hadi Sadeghian et al; Indian J Pathol Microbiol; 2011 Oct-Dec;54(4):720-4.
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Lipid Level, Lipid Variability, and Risk of Multiple Myeloma; Taewoong Choi,et al; Cancers (Basel). 2021 Feb; 13(3):540.
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Diabetes Could Speed Progression of Blood Cancer Myeloma; Urvi A Shah et al; Blood Adv (2024) 8 (1): 236–247.
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The Bone Marrow Microenvironment in B-Cell Development and Malignancy; Anastasia M Hughes et al; Cancers (Basel), 2022 Apr 22;14(9):2089.
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Recent insights into the role of the microbiome in malignant and benign hematologic diseases; Brunno Fattizzo et al; Critical Reviews in Oncology/Hematology Volume 160, April 2021, 103289
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Lipids in the Bone Marrow: An evolving perspective; Elizabeth Rendina-Ruedy, Clifford J Rosen; Cell Metab, 2020 Feb 4;31(2):219-231.
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Bolstering fat cells offers potential new leukemia treatment; October 16, 2017, MdMaster University; Science Daily
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The gut-bone axis: how bacterial metabolites bridge the distance; Mario M Zeiss et al; J Clin Invest. 2019;129(8):3018–3028
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Intestinal Microbiome and Lymphoma Development; Mitsuko L. Yamamoto, Robert H. Schiestl; Cancer J. 2014 May-Jun; 20(3): 190–194.
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Gut microbiome in multiple myeloma: Mechanisms of progression and clinical applications; Liuyun Zhang et al; Front Immunol. 2022 Dec 8:13:1058272.
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Alterations of gut microbiome accelerate multiple myeloma progression by increasing the relative abundances of nitrogen-recycling bacteria; Xingxing Jian et al; Microbiome 8, 74 (2020)
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Role of Stem Cell Transplantation in Multiple Myeloma; Srinivas Devarakonda et al; Cancers (Basel). 2021 Feb; 13(4): 863.
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Long-term outcomes after autologous stem cell transplantation for multiple myeloma; Katherine K. Nishimura et al; Blood Adv (2020) 4 (2): 422–431.
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Long-term outcomes of allogeneic stem cell transplant in multiple myeloma; Walker M. Schmidt et al; Blood Cancer Journal volume 13, Article number: 126 (2023)
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A dendritic cell vaccine was safe and induced immune responses in patients with multiple myeloma; American Association for Cancer Research.ScienceDaily, 22 September 2023.
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Impact of HIV on Clinical Presentation and Outcomes of Individuals with Multiple Myeloma; Smith Giri; Blood (2018) 132
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Cholesterol levels in patients with multiple myeloma; Irfan Yavasoglu et al; Ann Hematol. 2008 Mar;87(3):223-8
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Statins Are Associated With Reduced Mortality in Multiple Myeloma; Sanfilippo, J Clin Oncol; 2016 Nov 20;34(33):4008-4014.